Myocardial contusion
Blunt myocardial injuryMyocardial contusion is a bruise of the heart muscle.
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Causes
The most common causes are:
- Car crashes
- Getting hit by a car
- Cardiopulmonary resuscitation (CPR)
- Falling from a height, most often greater than 20 feet (6 meters)
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Symptoms
A severe myocardial contusion may lead to signs and symptoms of a heart attack.
Symptoms can include:
- Pain in the front of the ribs or breastbone
- Feeling that your heart is racing
- Lightheadedness
- Nausea or vomiting
- Shortness of breath
- Weakness
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Exams and Tests
The health care provider will perform a physical exam. This may show:
- Bruise or scrapes on the chest wall
- Crunching sensation when touching the skin if there are rib fractures and puncture of the lung
- Fast heartbeat
- Irregular heartbeat
- Low blood pressure
- Rapid or shallow breathing
- Tenderness to the touch
- Abnormal chest wall movement from rib fractures
Tests may include:
- Blood tests (cardiac enzymes, such as Troponin-I or T or CKMB)
- Chest x-ray
- CT scan of the chest
- Electrocardiogram (ECG)
- Echocardiogram
These tests may show:
- Problems with the heart wall and the ability for the heart to contract
- Fluid or blood in the thin sac surrounding the heart (pericardium)
- Rib fractures, lung or blood vessel injury
- Problem with the heart's electrical signaling (such as a bundle branch block or other heart block)
- Fast heartbeat starting at the sinus node of the heart (sinus tachycardia)
- Abnormal heartbeat starting in the ventricles or lower chambers of the heart (ventricular dysrhythmia)
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Treatment
In most cases, you will be closely monitored for at least 24 hours. An ECG will be done continually to check your heart function.
Emergency room treatment may include:
- Catheter placement through a vein (IV)
- Medicines to relieve pain, heart rate disturbances, or low blood pressure
- Pacemaker (temporary, may be permanent later)
- Oxygen
Other therapies may be used to treat a heart injury, include:
- Chest tube placement
- Draining blood from around the heart
- Surgery to repair blood vessels in the chest
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Outlook (Prognosis)
People with a mild myocardial contusion will recover completely most of the time.
Serious heart injuries can increase your risk for heart failure or heart rhythm problems.
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Prevention
The following safety tips may help prevent a heart bruise:
- Wear a seat belt when driving.
- Choose a car with air bags.
- Take steps to ensure safety when working at heights.
References
Boccalandro F, Shreyder K. Traumatic heart disease. In: Levine GN, ed. Cardiology Secrets. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 72.
Ledgerwood AM, Lucas CE. Blunt cardiac injury. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1241-1245.
Raja AS. Thoracic trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 38.